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transcript
Rational Drug Therapy
Program
WVBMS Drug Utilization Board
February 25, 2015
Presented by Stephen A. Small, M.S., R.Ph.
West Virginia University School of Pharmacy
November 2014 Program Summary EO/PA Status Count % EO Total PA Count % PA Total Total Count % of Total
APPROVED 3604 76.88% 3566 57.35% 7170 65.74%
CALLTRACK 0 0.00% 196 3.15% 196 1.80%
CLOSED 65 1.39% 143 2.30% 208 1.91%
DENIED 717 15.29% 1756 28.24% 2473 22.68%
INPROCESS 1 4.78% 52 0.84% 53 0.49%
MEDREVIEW 224 1.64% 408 6.56% 632 5.79%
PENDING 77 1.64% 97 1.56% 174 1.60%
Total Program 4688 40.05% 6218 53.13% 10906 93.18%
# Member ID# s 4510 1.04 6026 1.03 10536 1.04
December 2014 Program Summary
EO/PA Status
EO
Count
% of EO
Total PA Count % of PA Total Total Count % of Total
APPROVED 4523 78.89% 4447 59.26% 8970 67.76%
CALLTRACK 0 0.00% 258 3.44% 258 1.95%
CLOSED 94 1.64% 224 2.99% 318 2.40%
DENIED 839 14.63% 1899 25.31% 2738 20.68%
INPROCESS 2 3.16% 70 0.93% 72 0.54%
MEDREVIEW 181 1.64% 445 5.93% 626 4.73%
PENDING 94 1.64% 161 2.15% 255 1.93%
Total Program 5733 41.00% 7504 53.67% 13237 94.66%
# Member ID# s 5521 1.04 7211 1.04 12732 1.04
January 2015 Program Summary
EO/PA Status EO Count
% of EO
Total PA Count
% of PA
Total Total Count % of Total
APPROVED 3946 76.86% 5236 59.59% 9182 65.96%
CALLTRACK 0 0.00% 242 2.75% 242 1.74%
CLOSED 128 2.49% 247 2.81% 375 2.69%
DENIED 746 14.53% 2331 26.53% 3077 22.10%
INPROCESS 3 4.25% 88 1.00% 91 0.65%
MEDREVIEW 218 1.81% 474 5.39% 692 4.97%
PENDING 93 1.81% 169 1.92% 262 1.88%
Total Program 5134 34.72% 8787 59.42% 13921 94.14%
# Member ID# s 4911 1.05 8496 1.03 13407 1.04
November 2014 Edit Overrides (EO)
EOStatus
7069
Ther.Dup
7073
Early
Refill
7026 Disp
> Exceeds
Max
7196 Qnty
Sum>Time
Limits
7155 Max
Units
7187 User
Max Units
Exceeded
APPROVED 83.09% 82.84% 65.27% 50.38% 80.77% 75.51%
CLOSED 1.22% 1.93% 0.88% 3.82% 0.00% 0.00%
DENIED 10.21% 11.36% 28.98% 38.17% 9.62% 16.33%
INPROCESS 0.00% 0.08% 0.00% 0.00% 0.00% 0.00%
MEDREVIEW 3.56% 2.74% 3.32% 6.87% 4.81% 5.10%
PENDING 1.92% 1.05% 1.55% 0.76% 4.81% 3.06%
Total EO's 2135 1241 452 131 104 98
December 2014 Edit Overrides (EO)
EO Status
7069
Ther.Dup
7073 Early
Refill
7026 Disp >
Exceeds
Max
7155 Max
Units
7196 Qnty
Sum>Time
Limits
7187 User
Max Units
Exceeded
APPROVED 84.55% 82.59% 78.57% 75.84% 52.24% 69.11%
CLOSED 1.03% 3.42% 0.86% 0.00% 2.99% 0.81%
DENIED 10.00% 10.85% 17.37% 14.09% 34.33% 18.70%
INPROCESS 0.04% 0.00% 0.09% 0.00% 0.00% 0.00%
MEDREVIEW 2.63% 2.18% 1.82% 6.04% 8.21% 3.25%
PENDING 1.74% 0.95% 1.30% 4.03% 2.24% 8.13%
Total EO's 2240 1373 1157 149 134 123
January 2015 Edit Overrides (EO)
EO Status
7069
Ther.Dup
7073 Early
Refill
7026 Disp >
Exceeds Max
7187 User
Max Units
Exceeded
7196 Qnty
Sum>Time
Limits
7155 Max
Units
APPROVED 83.10% 80.93% 69.19% 81.41% 55.13% 80.83%
CLOSED 1.05% 5.97% 1.54% 3.21% 2.56% 1.67%
DENIED 10.34% 10.23% 24.23% 8.97% 29.49% 10.83%
INPROCESS 0.14% 0.00% 0.00% 0.00% 0.00% 0.00%
MEDREVIEW 3.23% 2.13% 2.80% 3.21% 8.33% 5.00%
PENDING 2.14% 0.74% 2.24% 3.21% 4.49% 1.67%
Total EO's 2195 1222 714 156 156 120
Top 10 Therapy Duplication
Classes
HIC3 Definition
H3A ANALGESICS, NARCOTICS
H2S SELECTIVE SEROTONIN REUPTAKE INHIBITOR (SSRIS)
H7C SEROTONIN-NOREPINEPHRINE REUPTAKE-INHIB (SNRIS)
S2B NSAIDS, CYCLOOXYGENASE INHIBITOR TYPE
A4D HYPOTENSIVES, ACE INHIBITORS
D4J PROTON-PUMP INHIBITORS
H6H SKELETAL MUSCLE RELAXANTS
M4E LIPOTROPICS
A4F HYPOTENSIVES,ANGIOTENSIN RECEPTOR ANTAGONIST
H2E SEDATIVE-HYPNOTICS,NON-BARBITURATE
Top 20 Duplications (January) GCN Seqno Drug Name Drug Strength
047430 HYDROCODONE/ACETAMINOPHEN 5 MG-325MG
046404 VENLAFAXINE HCL 75 MG
004222 OXYCODONE HCL/ACETAMINOPHEN 5 MG-325MG
046214 FLUOXETINE HCL 20 MG
047431 HYDROCODONE/ACETAMINOPHEN 7.5-325MG
057892 DULOXETINE HCL 30 MG
048977 OXYCODONE HCL/ACETAMINOPHEN 10MG-325MG
046229 SERTRALINE HCL 100 MG
030623 HYDROCODONE/ACETAMINOPHEN 10MG-325MG
027462 PANTOPRAZOLE SODIUM 40 MG
057893 DULOXETINE HCL 60 MG
046204 CITALOPRAM HYDROBROMIDE 40 MG
050760 ESCITALOPRAM OXALATE 20 MG
000391 LISINOPRIL 20 MG
046405 VENLAFAXINE HCL 150 MG
046228 SERTRALINE HCL 50 MG
043137 OMEPRAZOLE 40 MG
000392 LISINOPRIL 40 MG
029157 MELOXICAM 15 MG
046215 FLUOXETINE HCL 40 MG
Top 20 Early Refills (January) GCN Seqno Drug Name Drug Strength
021414 GABAPENTIN 300 MG
021415 GABAPENTIN 400 MG
019103 IMMUNE GLOBULIN,GAMMA(IGG) 10 %
006373 BLOOD SUGAR DIAGNOSTIC
046229 SERTRALINE HCL 100 MG
023139 TRAMADOL HCL 50 MG
066636 BUPRENORPHINE HCL/NALOXONE HCL 8 MG-2 MG
047430 HYDROCODONE/ACETAMINOPHEN 5 MG-325MG
028090 ALBUTEROL SULFATE 90 MCG
004560 CLONAZEPAM 0.5 MG
062867 INSULIN GLARGINE,HUM.REC.ANLOG 100/ML (3)
000346 CLONIDINE HCL 0.1 MG
021413 GABAPENTIN 100 MG
046228 SERTRALINE HCL 50 MG
003775 ALPRAZOLAM 1 MG
004222 OXYCODONE HCL/ACETAMINOPHEN 5 MG-325MG
008209 FUROSEMIDE 40 MG
046241 TRAZODONE HCL 50 MG
046404 VENLAFAXINE HCL 75 MG
013318 METFORMIN HCL 500 MG
Top 20 Exceds Max Allowed (Jan) GCN Seqno Drug Name Drug Strength
027462 PANTOPRAZOLE SODIUM 40 MG
046405 VENLAFAXINE HCL 150 MG
021414 GABAPENTIN 300 MG
043137 OMEPRAZOLE 40 MG
021415 GABAPENTIN 400 MG
033530 OMEPRAZOLE 20 MG
048702 DEXTROAMPHETAMINE/AMPHETMN 20 MG
046213 FLUOXETINE HCL 10 MG
046451 MIRTAZAPINE 30 MG
046404 VENLAFAXINE HCL 75 MG
046403 VENLAFAXINE HCL 37.5 MG
057892 DULOXETINE HCL 30 MG
057893 DULOXETINE HCL 60 MG
048703 DEXTROAMPHETAMINE/AMPHETMN 30 MG
050760 ESCITALOPRAM OXALATE 20 MG
004027 METHYLPHENIDATE HCL 20 MG
004026 METHYLPHENIDATE HCL 10 MG
034359 DEXTROAMPHETAMINE/AMPHETMN 30 MG
017026 CLOBAZAM 10 MG
041805 GABAPENTIN 600 MG
Top 20 Quantity/Time Limit (Jan) GCN Seqno Drug Name Drug Strength Count
005039 ALBUTEROL SULFATE 2.5 MG/3ML 9
016392 ONDANSETRON HCL 4 MG 9
009537 NYSTATIN 100000/ML 8
047431 HYDROCODONE/ACETAMINOPHEN 7.5-325MG 8
008334 COLCHICINE 0.6 MG 7
030623 HYDROCODONE/ACETAMINOPHEN 10MG-325MG 7
047430 HYDROCODONE/ACETAMINOPHEN 5 MG-325MG 7
048977 OXYCODONE HCL/ACETAMINOPHEN 10MG-325MG 6
005258 COLLAGENASE CLOSTRIDIUM HIST. 250 UNIT/G 6
043706 OSELTAMIVIR PHOSPHATE 75 MG 6
051913 APREPITANT 125MG-80MG 5
026098 MEDROXYPROGESTERONE ACETATE 150 MG/ML 5
041563 ONDANSETRON 8 MG 4
041562 ONDANSETRON 4 MG 4
026721 AZITHROMYCIN 250 MG 4
022141 FLUCONAZOLE 150 MG 4
016393 ONDANSETRON HCL 8 MG 4
022624 AZITHROMYCIN 500 MG 4
046474 OXYCODONE HCL 15 MG 4
048976 OXYCODONE HCL/ACETAMINOPHEN 7.5-325MG 3
November 2014 PAs
Status
Narcotic
Withdrawal
Agents
Atypical
Anti-
psychotics
Amphet-
amines
Anti-
convulsants
ADD
Agents
Proton
Pump
Inhibitors
APPROVED 87.21% 68.96% 78.94% 65.74% 74.46% 17.74%
CALLTRACK 4.68% 4.23% 2.77% 2.03% 2.16% 4.84%
CLOSED 2.03% 3.00% 3.19% 2.54% 2.16% 1.61%
DENIED 2.81% 17.81% 10.85% 23.10% 13.85% 72.04%
INPROCESS 0.94% 0.35% 0.21% 0.00% 0.00% 0.00%
MEDREVIEW 1.56% 4.06% 4.04% 5.84% 7.36% 3.23%
PENDING 0.78% 1.59% 0.00% 0.76% 0.00% 0.54%
Totals 641 567 470 394 231 186
Status
Heparin &
Related
Products Narcotics
DPP-4
Inhibitors Lipo-tropics
GPL-1
Incretins
SGLT-2
Inhibitors
APPROVED 85.92% 43.97% 66.92% 39.02% 59.13% 48.48%
CALLTRACK 0.00% 2.13% 0.75% 1.63% 3.48% 1.01%
CLOSED 7.75% 2.13% 0.00% 0.81% 1.74% 2.02%
DENIED 3.52% 42.55% 26.32% 45.53% 27.83% 39.39%
INPROCESS 0.00% 0.71% 1.50% 0.00% 0.87% 0.00%
MEDREVIEW 1.41% 7.09% 2.26% 11.38% 3.48% 2.02%
PENDING 1.41% 1.42% 2.26% 1.63% 3.48% 7.07%
Totals 142 141 133 123 115 99
November 2014 PA Status Graph
November 2014 PA Distribution
December 2014 PAs
Status
Narcotic
Withdrawal
Agents
Atypical
Anti-
psychotics
Amphet-
amines
Anti-
convulsants
Proton
Pump
Inhibitors
ADD
Agents Narcotics
APPROVED 83.63% 68.50% 79.01% 70.45% 55.98% 68.40% 50.89%
CALLTRACK 4.91% 3.39% 4.24% 1.24% 2.15% 3.35% 3.13%
CLOSED 3.39% 3.55% 2.95% 3.51% 0.96% 3.72% 2.23%
DENIED 5.15% 18.09% 9.21% 20.45% 37.08% 17.10% 33.48%
INPROCESS 0.23% 0.16% 0.00% 0.00% 0.48% 0.00% 0.00%
MEDREVIEW 1.52% 5.01% 4.24% 3.31% 3.11% 7.43% 8.04%
PENDING 1.17% 1.29% 0.37% 1.03% 0.24% 0.00% 2.23%
Totals 855 619 543 484 418 269 224
Status
Alpha-2
ADHD
Agents
Heparin &
Related
Products
DPP-4
Inhibitors
GPL-1
Incretins
SGLT-2
Inhibitors
DIRECT
FACTOR
XA INHIB SNRI's
Lipo-
tropics
APPROVED 71.50% 89.33% 65.07% 58.82% 47.62% 84.82% 42.59% 35.00%
CALLTRACK 1.87% 2.00% 0.68% 1.47% 0.00% 3.57% 8.33% 2.00%
CLOSED 3.74% 4.00% 1.37% 1.47% 3.17% 6.25% 0.00% 4.00%
DENIED 20.09% 3.33% 26.03% 27.21% 38.10% 3.57% 39.81% 39.00%
INPROCESS 0.47% 0.00% 0.68% 0.00% 0.00% 0.00% 0.00% 1.00%
MEDREVIEW 0.93% 0.00% 2.74% 1.47% 2.38% 0.89% 8.33% 18.00%
PENDING 1.40% 1.33% 3.42% 9.56% 8.73% 0.89% 0.93% 1.00%
Totals 214 150 146 136 126 112 108 100
November 2014 PA Status Graph
November 2014 PA Distribution
January 2015 PAs
Status
Narcotic
Withdraw
al Agents
Atypical
Anti-
psychotics
Amphet-
amines
Proton
Pump
Inhibitors
Anti-
convulsants
ADD
Agents
Lipo-
tropics
Top Anti-
Parasitics
Alpha-2
Rec
Agonist
APPROVED 86.35% 71.81% 77.22% 60.45% 70.94% 70.65% 26.69% 83.98% 79.82%
CALLTRACK 4.55% 2.52% 4.19% 1.13% 1.70% 5.12% 1.59% 2.16% 0.45%
CLOSED 3.28% 2.36% 3.69% 1.88% 1.51% 6.48% 0.40% 2.16% 0.90%
DENIED 4.13% 17.95% 9.55% 32.58% 19.25% 12.63% 67.73% 7.79% 17.04%
INPROCESS 0.32% 0.16% 0.34% 0.19% 0.19% 0.00% 0.00% 0.00% 0.00%
MEDREVIEW 0.74% 3.78% 4.36% 3.01% 4.72% 4.44% 2.39% 0.43% 0.90%
PENDING 0.63% 1.42% 0.67% 0.75% 1.70% 0.68% 1.20% 3.46% 0.90%
Totals 945 635 597 531 530 293 251 231 223
Status Narcotics
DPP-4
Inhibitors
Heparin &
Related
Products
GPL-1
Incretins
Inhaled
Steroids
Direct
Factor XA
INHIBIT
SGLT-2
Inhibitors SNRIs
Ophth Anti-
Infflam.
Immune
APPROVED 46.89% 67.65% 80.86% 53.90% 20.55% 86.07% 48.36% 47.32% 72.90%
CALLTRACK 1.91% 5.88% 1.85% 1.95% 1.37% 2.46% 3.28% 1.79% 0.00%
CLOSED 1.91% 19.41% 5.56% 3.25% 0.00% 2.46% 0.82% 2.68% 0.93%
DENIED 40.19% 1.18% 6.17% 35.06% 69.86% 6.56% 37.70% 33.04% 18.69%
INPROCESS 0.48% 0.00% 0.62% 0.00% 1.37% 0.00% 1.64% 0.00% 0.93%
MEDREVIEW 7.18% 1.76% 3.70% 1.30% 6.16% 1.64% 3.28% 11.61% 0.93%
PENDING 1.44% 4.12% 1.23% 4.55% 0.68% 0.82% 4.92% 3.57% 5.61%
Totals 209 170 165 154 146 122 122 112 107
January 2015 PA Status Graph
January 2015 PA Distribution
Issues
Any Questions?